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Summary of guidance relevant to general practice in June 2012

Venous thromboembolic diseases

People who present to hospital with blood clots in the legs or lungs should be offered treatment within 4 hours and have their investigative tests including scans within 24 hours, according to latest guidelines.

Those aged 40 and over who develop a blood clot should also be tested to see whether they have an underlying cancer.

Currently, some patients encounter delays as tests and scans are unavailable at hospitals over the weekend or out-of-hours. During this time, the risk of developing a potentially fatal pulmonary embolism (PE) increases significantly.

The opportunity to check for cancer is also being missed, despite estimates suggesting that one in 10 people with a blood clot have an underlying cancer.

NICE recommends in its new guidance on venous thromboembolic diseases that health professionals make a diagnosis using the Wells score which has two versions, one for suspected DVT and one for PE.

Health professionals should take a history, chest x-ray and blood tests when patients, aged 40 and over, present for the first time with deep vein thrombosis (DVT) or PE for which there is no obvious cause, and who are not already known to have a cancer.

If this suggests a cancer, they should then consider further investigations with an abdomino-pelvic CT scan or a mammogram for women.

The guidance also sets out new recommendations for treating blood clots among cancer patients who benefit from the use of different blood thinners.

Patients with cancer should be treated with low weight molecular heparin given as an injection once a day for six months. This reduces the risk of the blood clot coming back compared to treating patients who don't have cancer for approximately three months with warfarin.

Support tools to help you put this guidance into practice

NICE has produced a number of suport tools for this guideline including; templates for the two-level Wells score for deep vein thrombosis and pulmonary embolism, slide sets, a training plan, clinical case scenarios, clinical audit tools, and a baseline assessment tool.

Autism in adults

Early diagnosis of adults with autism can help them access the services they need, including assistance with getting jobs and keeping hold of them, says NICE.

Around 500,000 people in the country have autism, a neurodevelopmental condition with features that vary greatly in severity, and that can fluctuate over time.

The majority of people with autism are diagnosed in childhood and adolescence. However, if left undiagnosed or undetected, the condition can result in feelings of isolation, confusion and social exclusion.

Many healthcare professionals often overlook the condition, meaning that adults with autism can encounter barriers to accessing the services that are available and which help them lead independent lives.

NICE's first guideline on the referral, diagnosis and management of autism in adults and provides a full clinical pathway of care for those with the condition.

The guideline forms part of the Department of Health's autism strategy, which has a range of aims, including providing a clear and consistent pathway for diagnosis, and providing help for adults with adults to get into work and keep jobs.

NICE says GPs and other healthcare professionals should consider a diagnostic assessment for possible autism under certain specific conditions.

These are when a person has one or more features including persistent difficulties in social interaction or social communication, stereotypic (rigid and repetitive) behaviours, and resistance to change or restricted interests.

The person should also have one or more of the following features, if a diagnostic assessment for possible autism is to be considered:

  • problems in obtaining or sustaining employment or education
  • difficulties in initiating or sustaining social relationships
  • previous or current contact with mental health or learning disability services
  • a history of a neurodevelopmental condition (including learning disabilities and attention deficit hyperactivity disorder) or mental disorder.

GPs and other healthcare professionals should consider using the Autism Spectrum Quotient (ASQ) for adults with possible autism who do not have a moderate or severe learning disability.

A comprehensive assessment for autism should be taken if the person has an ASQ score of over six, or autism is suspected based on clinical judgement.

Individual supported employment programmes should be considered for adults with autism without a learning disability or with a mild learning disability, who are having difficulty obtaining or maintaining employment.

The programme should include help with writing CVs and job applications and preparing for interviews, training for the identified work role and work-related behaviours, and should carefully match the person with autism with the job.

Support tools to help you put this guidance into practice

A range of implementation tools have been produced to help support the use of this guideline, including a baseline assessment tool and a series of clinical audit tools.

27 June 2012

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Selected, reliable information for health and social care in one place

Accessibility | Cymraeg | Freedom of information | Vision Impaired | Contact Us | Glossary | Data protection | Copyright | Disclaimer | Terms and conditions

Copyright 2014 National Institute for Health and Care Excellence. All rights reserved.